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MAY 24, 2011 • VOLUME 4 • NUMBER 3	SEND TO A FRIEND

Data Central

Virginia Hospital Center: A Single Archive for Cardiology and Radiology

By Cat Vasko

Arlington-based Virginia Hospital Center (VHC) performs nearly 200,000 imaging studies annually, between its cardiology and radiology departments. Behyar Ghahramani, manager of medical systems engineering at VHC, estimates that cardiology accounts for between 45,000 and 50,000 studies a year, while radiology is responsible for 140,000 to 150,000. Imaging related to other specialty areas in the hospital is routed to the radiology PACS as well.

“We wanted to have one imaging application for all of the imaging data in the enterprise,” Ghahramani explains. “Using the same applications limits the cost of moving the data from the SAN to the second tier and off-site storage facility. It offers both efficiencies of scale and ease of management.”

In November 2010, Ghahramani got his wish when VHC implemented the Synapse Cardiovascular integrated image and information system from FUJIFILM Medical Systems USA, Stamford, Connecticut. VHC had been using the company’s Synapse PACS for more than a decade, and the addition of the cardiovascular information system enabled the hospital to establish a single archive for both radiology and cardiology images. “We already had the infrastructure to distribute radiology images,” Ghahramani says. “They go through the RIS, which extends to the information portal. Having that already in place meant we didn’t have to make two interfaces.”

Both Synapse Cardiovascular and the Synapse PACS are tied to VHC’s SAN, but the SAN offers limited local storage for cardiology images, routing them instead through the Synapse PACS—immediately, in the case of catheterization-laboratory images, or after a 12-hour delay, in the case of echocardiography.

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University Radiology Group: A Common Archive for a Distributed-reading Solution

By Julie Ritzer Ross

Alberto Goldszal, PhD, MBA Archiving and distributing the large data sets associated with images can be a challenge for many radiology practices. University Radiology in New Brunswick, New Jersey, would encounter a larger-than-usual share of obstacles on this front if it were not for a carefully thought-out image-archiving and -distribution strategy built upon the unique attributes of its PACS technology.

University Radiology employs more than 90 radiologists and reads more than 950,000 exams per year—about 650,000 for six hospitals, with the remaining exams done at its 10 imaging centers. The group’s clients are independent, unaffiliated locations that are geographically distributed throughout New York, New Jersey (its primary market), and Pennsylvania.

University Radiology also has an in-house night-coverage service, with radiologists reading from an even more geographically disparate area that extends from Illinois to Washington to California—and across the world to Germany and Israel. About a million studies are added to the group’s image archive annually.

Avoiding Failure

Alberto Goldszal, PhD, MBA, is University Radiology’s CIO. He notes that in deciding how to configure the archive, several years ago, he and his colleagues had one clear objective in mind—to avoid any single point of failure and ensure access to images 24 hours a day, 365 days a year, without breaking the bank. Implementing a redundant image archive was deemed the best way to attain the required failover capability.

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Patient Privacy

Penalties Soar, HIPAA Gets Update With HITECH Act Provisions

By Cheryl Proval

Adam Greene, JD, MPH Soaring penalties and new privacy, security, and breach-notification provisions intended to modernize HIPAA have raised the stakes in the patient-privacy arena and rewritten the HIPAA rulebook. Radiology departments, practices, and their business associates are well advised to sit up and take notice.

Adam Greene, JD, MPH, formerly an attorney with the US DHHS Office for Civil Rights, offered an overview of the changes in a February 21 session at the annual meeting of Health Information and Management Systems Society in Orlando, Florida. Some changes, such as the exponential increase in penalties and the responsibility for breach notification for business associates, are already in effect, but others will kick in after the final rule is published (sometime this year).

“It is quite a different playground that we are working in,” Greene says, than it was before the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Adapting circa-2000 policies to the era of the electronic health record (EHR) and cloud computing presents new opportunities to meet patient privacy and data-security requirements, but also new challenges, Greene says. At the very least, these changes call for providers to revisit and update their risk-management programs, to reassess what the reasonable and appropriate safeguards mandated by HIPAA regulations are, and to implement new forms of data-integrity maintenance and availability of information.

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CHIME Says Patient Opt-out Clause Makes the ACO a Nonstarter
CHIME has joined a growing list of critics of the proposed accountable-care organization (ACO) regulations, calling into question the patient’s ability to restrict access to his or her patient records. If the beneficiary has the option of withholding this information, then the ACO has a limited ability to improve that patient’s care, and the patient should be denied access to the ACO primary-care network. Another proposed option would be not to include that patient’s health record when calculating whether the ACO should receive shared savings.